Saturday, May 31, 2008

No treatment evidence in Post-op. metacarpophalangeal arthroplasty in 2008!

Rheumatoid arthritis is encountered here in India with consistent regularity. MCP joints are the commonest joint to be affected. In a chronic RA patient MCP joint is flexed & deviated to the ulnar side. This deformity produces a great functional disability. One of the surgical options is MCP joint arthroplasty. It has been performed for people with rheumatoid arthritis (RA) since the 1960s.
For eight to 12 weeks following surgery, patients wear hand splints and perform exercises to maintain and increase motion in the healing hand. Post-operative therapy regimes share common aims of encouraging MCP flexion and extension without the recurrence of flexion or ulnar deviation deformity.
In a study by Massy-Westropp N et al (2008) published in Cochrane database reviews compared the effectiveness of post-operative therapy regimes for increasing hand function after MCP arthroplasty in adults with rheumatoid arthritis.

The search included:
The Cochrane Musculoskeletal Group Register,
MEDLINE (January 1950 to August 2006),
EMBASE (January 1993 to August 2006),
CINAHL (January 1982 to August 2006),
Digital Dissertations (January 1960 to August 2006),
DARE (The Cochrane Library 2006, Issue 3),
Current Contents Connect (January 1998 to August 2006),
and AMED (January 1985 to August 2006)
These data bases were searched for randomised controlled trials and controlled clinical trials using rheumatoid arthritis and hand as the search terms and they evaluated the efficacy of a post-operative therapy regime for MCP arthroplasty.

Their search only identified one controlled clinical trial involving 22 participants.
The majority of the evidence for various splinting and exercise regimes consisted of case series and case studies.
Results from the one (poor quality) trial suggest that the use of continuous passive motion is not effective in increasing motion or strength after MCP arthroplasty.

They concluded:
Well-designed randomised controlled trials which compare the efficacy of different therapeutic splinting programmes following MCP arthroplasty are required.
As mentioned above just results of one study (silver level evidence) suggest that continuous passive motion alone is not recommended for increasing motion or strength after MCP arthroplasty.

Foot note: A strong & prudent post operative physiotherapy protocol designing is required. Difficult to execute the plan in India as it is rarely done in India.

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